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shock and exhaustion caused thereby, peritonitis, septicemia,
and, rarely, h:emorrhage.
The four modifications had all originated in Germany.
Frank, of Cologne, proposed, in 1881, a plan which was intended
to secure perfect drainage, and to make the oi)eration partially
extra-peritoneal. The uterine incision was made low down
anteriorly, and the round ligaments of the womb were drawn
together and secured with carbolized-silk sutures, thus shutting
off the incision from the peritoneal cavity; and from this blind
pouch drainage was secured through the vagina. In one (fatal)
case in which this operation was performed, the peritoneal cav-
ity was found at the autopsy to be quite free from fluids.
Kehrer, in 1882, proposed to open the uterus transversely in
its lower third anteriorly, partly to avoid the placenta, which.
however, was rarely attached at this point, and partly to pre-
vent the gaping of the uterine wound. This operation had been
done twice, once successfully.
Sanger, in 1881, proposed a modification of the Cmsarean
section which, so far as Dr. Lee had been able to learn, had
been practiced eight times in Germany with the result of saving
six women and eight children. It had been done three times
in this country, death taking place in each instance, apparently
because of delay in operating. Cohnstein, of Heidelberg, had
suggested that tlie uterus be turned out of the abdomen and download game poker texas holdem zynga poker offline free
opened longitudinally behind instead of in front, drainage to be
eflEected through a tube perforating Douglas's pouch. Dr. Lee
thought it not likely the opei'ation would ever be performed.
The substitutes for the Csesarean section were the Porro, or
Porro- Mliller, operation and Veit's modification thereof, and
laparo-elytrotomy as performed by Dr. Thomas. Porro per-
formed his operation of ampntating the womb and ovaries in
1876. The patient, a rhachitic primipara, recovered. The
modificati(ms of Porro's operation by Professor Miiller and Pro-
fessor Veit had not been followed by sufficient success to justi-
fy the hope that they would supplant the original operation. best poker freerolls no deposit usa
Up to this time Veit's operation had shown a general mortality
of 71'5 percent. ; MiiUer's had been entirely successful in Italy,
but less successful elsewhere. Dr. Harris, of Philadelphia,
stated that up to March, 1885, there had been 42 operations by
Miiller's modification, 21 mothers and 31 children being saved;
by the original Porro method, 109 operations, 46 mothers and
85 children being saved.
Regarding laparo-elytrotomy, it seemed little need he said
before the Academy, which had witnessed and welcomed its
chief ])ublic exposition by its distingnished author, Dr. Thomas.
If the application of surgical resources to obstetrics in the
ten or twenty years just past had been so beneficent, saving the
lives of hundreds of women and children, we had no cause to
fear that the future would be less productive of good.
Dr. W. M. Polk referred to the advances which obstetrics,
aided by surgery, had made in recent years, and added that, as
in every case when the pendulum was held to one side, when it
swung it swung far to the other; so the surgeon to-day pro-
posed, possibly, to do more with his knife than the circum-
stances demanded.
The obstetrician and the gwiajcologist Ijad been compelled
to fight their way against opposition from two sources; one, the
indifference of the profession generally, wlio looked upon them
as physicians rather than as surgeons, and the other a more ac-
tive opposition from those engaged in surgical work ; and in the
conrse of poker freezeout rules this fight they had attained to what was now; regarded
July 24, 1886.] texas holdem poker 2 download full version free video strip poker supreme opponents pack free download full version
PROCEEDINGS OF SOCIETIES.
107
as an enviable position. Proof of this was to be seen in the re-
sults obtained by the obstetrician and the gynrecologist in ab-
dominal surgery. The day would come speedily when it are video poker machines illegal in illinois would
hardly ever be necessary to do that most repulsive of all ojjera-
tions, craniotomy. When we could avoid that by successful
Csesarean section, he thought we could affirm that the greatest
work in surgery belonged to the obstetric physician.
Dr. Fruitnight admitted that nature would often repair
tbe ruptured perinfeum when cleanliness was observed, but
he thought the primary operation should be performed, as
union was apt not to take place otherwise.
Dr. FoEDYCE Barker said he had not come with the expec-
tation of speaking, but, since he had been called upon, he would
make a few remarks. First, he thanked the author of tlie pa-
per and Dr. Polk for the kind allusion made to him as a con-
servative teacher. He accepted the position which had been
assigned him, that of a midwife or obstetrician rather than that
of a surgeon. He was not constitutionally inclined to accept
new propositions because they were new. On the other hand,
he was not inclined party poker free download games to deny their truth ; but he held his opin-
ion in abeyance until he zynga poker free download game had time to study the subject. He was
going to do to-night what play poker online for money on android he had not yet done, viz., express an
opinion which had come to be pretty definite in his own mind
regarding the operation for repairing the perina?um immediately
after the laceration. It had been several years since a gentle-
man prominent in the profession had stated it as his belief that
any physician who did not close a laceration of the perinffiura
by the immediate free download game zynga poker for blackberry operation neglected his duty. It had seemed
to Dr. Barker rather a strong proposition to make, but he had
concluded to wait governor of poker 2 free download full version tpb and watch. He would now state this fact,
which might seem a little audacious, bat lie would challenge any
contradiction of it : In no case of confinement which he had at-
tended had the secondary operation for rupture of the perinasum
ever been performed ; in no case had it ever been required. He
would not say that he had not had any lacerations. He had had
them, but he had watched them very carefully, and taken great
care of them, and free video strip poker games download the secondary operation had never been called
for. He spoke of private practice. He could not speak so posi-
tively regarding hospital patients, as he had not been able to fol-
low them so closely. In no case of his had the primary opera-
tion been performed until last winter. * It occurred world series of poker texas hold'em mobile game free download at a time
when a peculiar form of epidemic prevailed, lasting from about
the first of January until the first of February. Usually no
symptoms manifested themselves until about the sixth day after
confinement, when they would explode violently, the tempera-
ture going up to 105° or 106° F., with an extremely rapid pulse
and hurried breathing. It so happened that he saw forty such
cases, but only one in his own practice. Only one patient died.
In five of the cases the primary operation for laceration of the
perina?am was performed; in only one did union take place, and
that patient aied four weeks later. His own case was one of
justo-minor pelvic contraction, and, after waiting longer than
usual, governor of poker apk v1.2.5 download free for android he delivered with Tarnier's forceps. The zynga texas holdem poker game bar free download child weighed
over eleven pounds. A very extensive perineal laceration took
place, which was brought together with sutures at once, but
union failed. He had repeatedly watched with great interest
the operation as performed byotliers. In two cases he had seen
shock, exhaustion, and dangerous haimorrhage. There might
be cases in which the condition of the patient was so favorable
that it would be wise to perform the primary operation, but he
should say it was safer as a rule to observe cleanliness and see
that the general functions of the system were healthfully per-
formed, with the hope that the patient would recover without
an operation, and in the m.ajority strip poker game for pc free download of cases that hope would not
be disappointed.
The title of free download games for pc governor of poker 2 Dr. Lee's paper suggested a wide field for dis-
cussion. Obstetric and gynseoological surgeons had produced a
revolution in all questions connected with abdominal surgery.
Dr. Barker referred to the discussion which took place between
Dr. free download game governor of poker 3 full version Sims and Dr. Wood a few years ago on the subject of lapa-
rotomy for wounds of the abdomen, and a case had been sug-
gested to his mind on that occasion from which the following
principle could be deduced, namely, that when the condition
suggesting the operation was due to a source of irritation which
was rapidly destroying life, and the operation would remove
that source of irritation, it was an argument in favor of per-
forming it. The case referred to was one of abdominal tumor
which had given rise video strip poker free download for android to pus in the abdomen and peritonitis.
Sir Spencer Wells was present, and, being asked whether the
patient's condition admitted of the operation, answered that,
when there was peritonitis with pus in the abdomen due to the
presence of a tumor which required an operation, the peritoni-
tis and pus were not contra-indications, but were indications